From the Guidelines
Post-traumatic stress disorder (PTSD) and sleep apnea have a significant bidirectional relationship, with each condition potentially worsening the other, and treating one condition may help improve the other, as suggested by a 2020 study published in the Annals of Internal Medicine 1. The relationship between PTSD and sleep apnea is complex, with sleep disturbances, including nightmares and insomnia, being common among individuals with PTSD, which can increase the risk of developing sleep apnea.
- Key factors to consider in this relationship include:
- The impact of sleep apnea on PTSD symptoms, with sleep fragmentation and oxygen desaturation potentially exacerbating PTSD symptoms and impairing recovery.
- The effectiveness of treating sleep apnea with continuous positive airway pressure (CPAP) therapy or mandibular advancement devices (MADs) in improving PTSD symptoms, as reported in a study comparing PAP therapy and MADs for patients with mild to moderate OSA, which found that MADs may result in similar overall treatment benefits due to increased use and patient preference 1.
- The importance of good sleep hygiene, regular sleep schedules, and avoiding substances that can worsen sleep apnea, such as alcohol and sedatives.
- Treatment options for PTSD and sleep apnea should be considered together, with a focus on improving overall sleep quality and reducing symptoms of both conditions. The use of MADs may be a viable alternative to CPAP therapy for patients with mild to moderate OSA and PTSD, due to increased patient preference and adherence, as reported in a randomized crossover trial of veterans diagnosed with OSA and PTSD 1.
From the Research
Relationship Between PTSD and Sleep Apnea
The relationship between post-traumatic stress disorder (PTSD) and sleep apnea is complex and bidirectional. Studies have shown that PTSD can increase the risk of developing sleep apnea, and conversely, sleep apnea can exacerbate PTSD symptoms.
Prevalence of Sleep Apnea in PTSD Patients
- A study published in 2014 found that veterans with PTSD have a high prevalence of obstructive sleep apnea (OSA) 2.
- Another study published in 2012 found that patients with PTSD have a higher rate of comorbid insomnia, which can impair CPAP adherence 3.
- A review of sleep disorders in patients with PTSD found that fragmented sleep induced by sleep-related breathing disorders, insomnia, and nightmares can impact recovery and treatment outcomes and worsen PTSD symptoms 4.
Impact of CPAP Therapy on PTSD Symptoms
- A study published in 2014 found that CPAP therapy can reduce the frequency of nightmares and improve overall PTSD symptoms in veterans with PTSD and OSA 2.
- A prospective study published in 2017 found that treatment of OSA with positive airway pressure (PAP) therapy is associated with improvement in PTSD symptoms among veterans 5.
- However, another study published in 2012 found that PTSD was associated with significantly less use of CPAP, and regular use of CPAP was lower among PTSD patients 3.
Association Between Sleep Apnea and PTSD Severity
- A study published in 2021 found that sleep apnea is associated with PTSD symptom severity in veterans with traumatic brain injury (TBI) 6.
- The study found that almost 32% of the sample reported being diagnosed with sleep apnea, and in those reporting sleep apnea, 32% also had probable PTSD 6.
- The regression analysis demonstrated that sleep apnea was significantly associated with PTSD symptom severity, even after controlling for relevant covariates 6.